According to recent population estimates made by the U.S. Census Bureau, about 39 million Americans are over 65 years of age, representing 13% of the U.S. Approximately 35% of those over age 65 in the U.S., or about 13.6 million older Americans, have a significant hearing loss that is sufficient to make them hearing-aid candidates. Yet, only about 20% of those who could benefit from hearing aids actually seek them out. Limitations in the accessibility and affordability of hearing health care seem to be primary factors underlying the low percentage of older Americans who purchase hearing aids. The purchase price of the hearing aids and the typical service- delivery model represent key factors that appear to limit the accessibility and affordability of hearing aids. As the production costs of the devices themselves are fairly low, the justification for the higher purchase prices is often grounded in the professional services provided in the selection, programming, fitting and evaluation of the devices. This project proposes to conduct research that would provide new knowledge about the impact of purchase price and service-delivery model on hearing-aid outcomes. The proposed study will acquire this knowledge through a Phase-II double-blinded, placebo-controlled, randomized clinical trial with five parallel branches. In addition to a placebo branch, the remaining four branches represent factorial combinations of service-delivery model (current best practices and over-the-counter simulation) and purchase price (low and typical). Non-inferiority analyses will be performed to compare the outcomes of the current best-practices model to alternative combinations of service-delivery model and purchase price. Based on the results obtained, the findings could have considerable impact on the accessibility and affordability of hearing health care for older adults with mild-to-moderate hearing loss. PUBLIC HEALTH RELEVANCE: About 13.6 million older Americans have mild-to-moderate hearing loss, but only one in five end up purchasing hearing aids. There is a critical need to improve the accessibility and affordability of hearing health care for these individuals. The focus of the proposed project is on the evaluation of the benefits provided by a high-quality hearing aid, as well as the impact of service-delivery model and purchase price on the observed benefits.